Yoga Intake & Liability Waiver

Yoga Intake & Liability Waiver
1. Contact Information *
2. Emergency Person & Contact Info *
3. I acknowledge that I have read this waiver of liability form. I fully understand its terms and conditions, and understand that I am giving up my right to sue Raleigh NC Yoga, LLC., its teachers and em *
4. Have you had any previous surgeries? Please describe. *
5. Are you on medication for any physical or mental illness? Please describe. *
6. If there are any other details you think we should know about your medical or family medical history, please describe below. *
7. I hereby give my consent for Raleigh NC Yoga/Y Respira to use my photograph, testimonials, essays, and likeness in all forms of media for advertising and any other lawful purposes. *
I understand there is an inherent risk associated with any exercise program including my voluntary participation in yoga that may result in injury. The exercises related to yoga will challenge my cardio-respiratory and musculoskeletal systems associated with; the aerobic, anaerobic, strength, power, agility, flexibility and breathing components of the program. I understand and am aware that the components of exercise/yoga are potentially hazardous activities and may cause injury. 
~ I acknowledge that I have either had a physical examination and/or have been given permission from my physician to participate in a yoga based exercise program or that I have decided to participate in an exercise program voluntarily and without the approval of my physician and do hereby assume all responsibility for my participation in any exercise/yoga or activity associated with Raleigh NC Yoga, LLC.

~ I, my heirs, or legal representatives, do hereby waive and release Raleigh NC Yoga, LLC. onsite at 2376 Ravenhill Dr. Raleigh, NC 27615 or at private, personal or corporate location, its teachers and employees from any and all liability and responsibility from injury, accident, illness, legal and medical fees sustained now or in the future resulting from my participation in any activity or use of equipment.
~ I understand that Raleigh NC Yoga, LLC. will provide an area for personal belongings to be held during class, however, I agree that Raleigh NC Yoga, LLC. is in no way responsible for the loss or damage of my belongings while I attend class.
~ I acknowledge that I have read this waiver of liability form. I fully understand its terms and conditions, and understand that I am giving up my right to sue Raleigh NC Yoga, LLC., its teachers and employees. I acknowledge that I am signing this agreement voluntarily, and intend by my signature to be a complete and unconditional release of liability to the greatest extent allowable by law.
Please sign here *
Raleigh NC Yoga, LLC. * 2376 Ravenhill Dr. Raleigh NC 27615 * Phone: 919.633.8999 * claudia@raleighncyoga.com